Behind the mask

Abstract: By using Tajikistan as a case, this study adopted a qualitative approach to understand the different dimensions which make households of migrants with tuberculosis vulnerable to food insecurity. A vulnerability framework was used to identify the risks that tuberculosis poses on households’ availability, accessibility and utilization of food. Then, these risks were analysed in relation to the coping strategies that households employ in order to reduce harm. Data were collected through semi-structured interviews, and observations. Findings highlighted that TB negatively impacts food accessibility, by affecting income-generating activities, labour productivity, and overall expenditure. On the other hand, it affects food utilization, by decreasing patients’ capacity to absorb nourishment and increasing their nutritional requirements. As a result, the gap between nutritional intake required, and household’s ability to access food becomes wider. Households manage the risks posed by tuberculosis by selecting different coping strategies such as borrowing from relatives in migration, taking loans, reducing their expenditures and food consumption, start working, diversify their income, and selling productive assets. As the treatment prolongs, the coping mechanisms employed become more detrimental, compromising their resources. In the long term, the combined effect of being continuously exposed to TB risks, and the negative consequences of the coping mechanisms employed endangers both household’s livelihoods and their food security.